Combat Operational Stress

Combat stress, sometimes called combat and operational stress or combat and operational stress reaction, is a common response to the mental and emotional effort active duty personnel exercise when facing tough and dangerous situations. Combat stress is similar to the muscle fatigue and soreness experienced after a tough physical workout.

Combat stress is not an illness and may be experienced by active duty personnel during both peace and war, due to stressful conditions during training, deployment, humanitarian missions, government support missions and other assignments.

Risk Factors

All active duty personnel are at risk for stress injuries, no matter how strong, seasoned or experienced. Everyone has a breaking point, and for everyone, that breaking point changes over time due to many internal and external factors, including:

Duration of current deployment greater than six months

Repeat deployments without sufficient time to recover

Sleeping less than 6-8 hours per day on average

Witnessing death close up, especially of other active duty personnel or civilian non-combatants

Being responsible for the death or serious injury of a non-combatant or allied combatant

Losing a close friend or valued leader in combat or other operations

Witnessing or participating in violations of the Law of War and the Marine Corps Code of Conduct

Being physically injured, especially if seriously

Sustaining a traumatic brain injury

Close brushes with death, especially if the individual believed they were going to die

Handling remains, especially of other active duty personnel

History of previous stress injuries, whether sustained during or prior to service

Previous mental health problems

Being new to the unit or lacking mutual trust with other unit members

Being impacted by family, relationship, or other home front stressors

Being young and inexperienced

Signs and Symptoms

Signs and symptoms of combat stress may be harder to detect. Common symptoms of combat stress can include:

Thought Process

Problems concentrating

Confusion

Having problems in making decisions or processing information

Memory loss

Having a hard time telling what is real

Re-experiencing events or flashbacks

Troubling memories or nightmares

Loss of trust

Hallucinations or delusions (that don’t go away with adequate sleep)

Emotions

Unusual or excessive anxiety, fear, worry or nervousness

Depression, despair or unexplained sadness

Numbness and lack of interest in life

Agitation and intense anger or irritability

Guilt and shame or a sense of failure

Feeling overwhelmed

Feelings of isolation

Mood swings

Loss of confidence and trust

Behavior

Withdrawing and avoiding others

Restlessness or fidgeting

Being over-watchful or overly concerned about safety

Angry outbursts

Crying

Changes in diet

Risky or careless behaviors, such as increased smoking, drug or alcohol use, and reckless driving

Staring into space (the “thousand-yard stare”)

Physical Symptoms

Problems sleeping

Exhaustion

Worsening health problems

Pounding heart and sweating; cold sweats

Problems with eating or digestion

Nausea, frequent urination or diarrhea

Trembling hands

Numbness, tingling or loss of function in limbs or other body parts

Headaches

Changes in vision

Resiliency Factors

All active duty personnel possess traits and abilities that make them resilient to the potentially damaging effects of combat and operational stress. All leaders are responsible for promoting resiliency in their units. Resiliency factors include:

Tough and realistic training

Knowing what to expect, at every turn

Being more mature

Having served in a previous operational deployment without physical or stress injury

Having faith in God, the Marine Corps, leaders, and peers

Being physically fit

Having a stable and supportive home and family life

Being good at pushing self-defeating thoughts or perceptions out of conscious awareness

Tending to cope with problems by taking action

Having an optimistic attitude

COS Continuum

The Marine Corps views combat operational stress along a continuum. It is a representation of how you or others are functioning with deployment-related stress:

Why Active Duty Personnel May Not Seek Help

Due to the stigma that surrounds behavioral health and stress problems, particularly among Marines, who pride themselves in their ability to endure extreme stress, fighting stigma begins with understanding its causes, which include:

Not understanding that stress injuries are like other physical injuries — treatable and not the individual’s fault

Believing that adverse reactions to stress are a sign of weakness or personal failure

Not knowing that even the h4est active duty member can suffer a stress injury

Fearing that having an emotional problem or getting help for it will negatively impact their careers

Fearing their peers will think less of them because they got help for a stress injury

Fearing their peers or leaders won’t trust them as much in future tough situations if they admit to having suffered a stress injury

Not understanding that the longer they wait to get help for stress injuries that don’t heal quickly on their own, the less likely they are to heal fully

Not realizing that avoiding getting help may place their unit members at risk because of decreased readiness and performance caused by untreated stress injury symptoms

Not realizing that avoiding getting help for persistent stress injuries can hurt their careers, relationships, and future health more than accepting help will

A command climate that discourages getting help or tells active duty personnel to just “suck it up” or “get over it”

Prevention

Just as it is the responsibility of all leaders to protect the physical health and welfare of their active duty personnel, it is also their responsibility to prevent stress injuries as much as possible. The following are leader actions to prevent Combat Operational Stress Continuum (COSIs):